Covid-19: Gear up to fight the Omicron threat

It might seem like the Omicron variant isn’t yet widespread in India, given the country has reported a little over 200 cases across 11 states and Union Territories. Nonetheless, AIIMS chief Dr Randeep Guleria is right in saying the country must prepare for any eventuality; we must learn from the spread of the variant in the UK where over 12,000 daily new cases are being reported. To begin with, the government must take a call, without delay, on whether a booster vaccine dose is to be administered.Delhi CM Arvind Kejriwal had requested the Centre to allow booster vaccinations.

While the efficacy of booster doses of the vaccines allowed in India is yet to be ascertained, the Centre must explore ways to bring in m-RNA vaccines, for which efficacy in booster regimes is being reported. A booster strategy is badly needed. After all, the Omicron variant is 3-4 times as infectious as the Delta variants. Local and state administrations imposing restrictions on gatherings, especially in view of the year-end festivities, is therefore a welcome step.

Kejriwal has said Delhi will send all positive samples for genome sequencing to catch Omicron—so far samples from travellers from high-risk countries, collected at airports, were being sent. Experts believe local transmission could already be under way and governments should mandate, post haste, sequencing of all positive samples instead of just overseas arrivals; recall that Reuters had reported that the INSACOG had flagged the Delta variant early, but the Union health ministry didn’t seem to share its concern in its early statements on the variant.

Science needs to inform policy.WHO DG Tedros Adhanom Ghebreyesus’s remarks earlier this month are of special import; Ghebreyesus exhorted countries to spare no effort to ensure distancing, mask-use and vaccination—all three being key to fighting off Omicron. In India, the Institute of Health Metrics and Evaluation showed that mask usage is currently at 59%—almost at the level in March, just before the deadly second wave—after having reached a high of 81% in May. Note, even this ‘high’ is quite a few percentage points below the universal mask coverage goal of 95%.

Distancing as observed from cell phone mobility data was already poor, with mobility at the typical level in late November itself. It is projected to worsen through December. Omicron’s virulence will eventually get settled from real world data. While there have been reports that it is milder than Delta and Alpha—researchers in Hong Kong claim it replicates 10 times slower in lung tissue than the original SARS CoV-2—reinfection risk from Omicron is, as per a calculation by researchers at the Imperial College London, more than five times Delta’s.

This also means previous infections and vaccination may not protect from an Omicron infection. Indeed, a growing body of research shows vaccines—possibly with the exception of Pfizer and Moderna booster regimens—may not stave off infection. Even though breakthrough risks will be high, India needs to understand that vaccination, especially the full, two-dose cover, will be important in preparing for Omicron as it will likely help prevent serious infection and fatalities in many cases, lessening the burden on healthcare infrastructure.

It will help against other existing variants and help check the evolution of newer ones. Given how, as per CoWIN data, second-dose vaccinations are still a low number, the government must pull all stops to ensure continued supply of an adequate quantum of vaccines even as it addresses any hesitancy/lethargy among citizens. The ICMR has designed a diagnostic kit for the variant and it could be worthwhile for the government to incentivise its production. The focus also has to be on further vaccine research, production as well as developing therapeutics that could help beat down virulence.